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Severina AS, Tskaeva AA, Yevloyeva MI, Shamhalova MS, Shestakova MV. [Simultaneous living donor pancreas-kidney transplantation in a patient with type 1 diabetes mellitus after program hemodialysis. Case report]. TERAPEVT ARKH 2023; 95:859-863. [PMID: 38159018 DOI: 10.26442/00403660.2023.10.202428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 01/03/2024]
Abstract
Simultaneous pancreas-kidney transplantation is an effective treatment option for end-stage renal disease with diabetes mellitus. Successful simultaneous pancreas-kidney transplantation allows achieving euglycemia, stabilizing existing microvascular complications and slowing their progression, improving the patient's quality of life, lipid and calcium-phosphorus metabolism, reducing the risks of cardiovascular events. Therefore, in view of the patient's severe general condition due to prolonged intoxication, hyperglycemia and other complications of chronic kidney disease, the earliest possible surgical treatment with minimization of the patient's stay on dialysis therapy is crucial to improve the outcome of transplantation.
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Affiliation(s)
- A S Severina
- National Medical Research Center for Endocrinology
| | - A A Tskaeva
- National Medical Research Center for Endocrinology
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Ventura-Aguiar P, Bayés-Genís B, Amor AJ, Cuatrecasas M, Diekmann F, Esmatjes E, Ferrer-Fàbrega J, García-Criado Á, Musquera M, Olivella S, Palou E, Paredes D, Perea S, Perez A, Poch E, Romano B, Escarrabill J. Patient Experience in Pancreas-Kidney Transplantation-A Methodological Approach Towards Innovation in an Established Program. Transpl Int 2022; 35:10223. [PMID: 35497883 PMCID: PMC9047730 DOI: 10.3389/ti.2022.10223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes mellitus and end-stage kidney disease. Due to the particularities of this population (often with multiple comorbidities) and of the surgery (only performed in a few centers), a comprehensive analysis of patients' experience along the SPKT process is crucial to improve patient care and add value to this procedure. Therefore, we applied a systematic and iterative methodology with the participation of both patients and professional teams working together to explore and identify unmet needs and value-adding steps along the transplant patient journey at an established pancreas transplant program. Four main steps (to comprehend, to explore, to experiment and to assess) led to several interventions around three major areas: Administration and logistics, information and communication, and perceived quality of assistance. As a result, both displacements to the hospital for diagnostic purposes and the time delay involved in joining the patient waiting list for transplantation were reduced in parallel to the administrative procedures. In conclusion, the methodological implementation of key organizational changes has great impact on overall patient experience. Further quantitative analysis from the patient's perspective will consolidate our program and may add new prototype service design components.
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Affiliation(s)
- Pedro Ventura-Aguiar
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Beatriu Bayés-Genís
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio J Amor
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Enric Esmatjes
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Joana Ferrer-Fàbrega
- Hepato-Bilio-Pancreatic Surgery and Digestive Transplant Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Radiology Department, Center for Imaging Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Silvia Olivella
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Palou
- Patient Experience, Hospital Clinic Barcelona, Barcelona, Spain
| | - David Paredes
- Transplant Coordination Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sonia Perea
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Anna Perez
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Barbara Romano
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
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Diabetes Mellitus in Living Pancreas Donors: Use of Integrated National Registry and Pharmacy Claims Data to Characterize Donation-Related Health Outcomes. Transplantation 2017; 101:1276-1281. [PMID: 27482962 DOI: 10.1097/tp.0000000000001375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. Although early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. METHODS We integrated national Scientific Registry of Transplant Recipients data (1987-2015) with records from a nationwide pharmacy claims warehouse (2005-2015) to examine prescriptions for diabetes medications and supplies as a measure of postdonation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. RESULTS Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio, 4.13; 95% confidence interval, 1.91-8.93; P = 0.0003). Use of insulin (11.1% vs 0%) and oral agents (20.0% vs 5.9%; odds ratio, 4.50, 95% confidence interval, 2.09-9.68; P = 0.0001) was also higher in pancreas donors. CONCLUSIONS Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.
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Kaku K, Kitada H, Noguchi H, Kurihara K, Kawanami S, Nakamura U, Tanaka M. Living Donor Kidney Transplantation Preceding Pancreas Transplantation Reduces Mortality in Type 1 Diabetics With End-stage Renal Disease. Transplant Proc 2015; 47:733-7. [DOI: 10.1016/j.transproceed.2014.12.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
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